Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | DO1422 | NV |
NPI | 1013134576 |
---|---|
Provider Name | Dr. Derek Michael Goffstein |
First Address | Las Vegas, NV 89148-1253 |
Second Address | Las Vegas, NV 89148-1253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 09/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013134576 | (05) | NV |